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HomeMy WebLinkAbout4681DOCUMENT CONVERSION SERVICES PROVIDED BY IMAGING & MICROFILM ACCESS, INC. www.scanyourdocs.com 631- 589 -8100 91.08 -1 -16 BOX 35 I, % r - I 16 ,:� ly, ;Tr ,' I $ �' " POS! 1PO1t 881PA� m�.. Laced d :/ PDUMU COt)!P!'! DllARDAMOr OF EMALTH 9Id111ta d tttneirem1aW Bath Seedoa. Cased. N.Y. IN12 anyhow r Plweli Pandil wu.k CAIEOFC011�AIK� a SaroeAg. �Y�1 P''s't # S r /�l/ 9 7- !r�•i2%1 ice' /���.:�'�- . �•- �..c:'�'�; :::�: •.y�= ;��►:;,�;.;:.�•= �::tii����.::=a� / ��. f awwowmm 1`0 ?'�7 '095- � G� a..t,a 1— / �- In M4 /'rJ. MW& / OwwdAP*rta/ t1at�.�Sf'?°✓r'�' (J�G�r✓ � >•C �- ROWWai--� �f I / IDde d Ptwvbwa A�awel Mite A" an 71 , � / /lI/ r ° Tow. x/ .g, ey f Date Subdivision Annroved - Fee Enclosed ❑ em.,,,r* 0.■+rs thy*. `% �� �L i'�✓ L . L.t, Am / FS see" 0* LJ n.pfi var.. Ilttiee d Daiera DNW Plow G P D O6j PM Nelmtla Is Roodred Wren M b on"doMd S"MeM S WNW SIoMw w Comm d �l s a.lm Sq* qaa u 2442 614 „41_,4 .5 TO b e aoft"ded b eda..�. a T WNW Sty* Phe>• Adkero / an 1-1 rd"Is Smppb Ddled b r Addaves Olrw 1)a)hh*e�attM 1 rpreeant that I am wholly and completely responsible for the design and location of the proposed system(s)s 1) that the se arab tewa • di oW s stem 00ee daai0ed will M Constructed as shown On the approt!ed amendment there to and In SC with the standards. rules an ragu s o pwKy Department of "Mah. am that on Completion.theroof a ••Certificate of Con jrd � nee° satisfactory to the Commisalow of Meanhwlll M sulOtltMO to the Depertmeta. end a written guasantp will the furnished the or assigns by the builder. that Yid buNNr will plese M pod .dperottnp comittio”' any on of Yld sewage disposal system den s immediately following the date Of the low - sea of the apprewl of the Certificate of Construction Compliance of the or or a herelot 2) that the drilled well demand aioee nM bell I 1 N Mown On the MOP 8, d Alen and that Yid well will be Mstalled t a rules and rae—UM of of the Putnam CoWaY Oepertmi" Of ""NIL + 9 Oats n� 1. • ' / sii�n,/ed P.E. FE, R•A APPROVED FOR CONSTItucTION, ThM approval expires two years Ift 'the dole` l t{ygetbn of t he building has been undertaken and is rMOeabha for cam or nosy a amended or modified when Con Iy by tM COTn11piO1M1�01•'MNRII. Any Change or alteretlon of Construction fee 1 a per N.. �jApproved for disposal of domestic and/ Iwte wata=fupply only. Rev. p Oeee •2 �� Tana UNTY DEPARO Ml?q-�j §tAITH; -01vislon q Etiviri iw1dwillif cilt"Ioi NAIA051i PUTN Ire, 1 TMIA!, _7 befmustl Ado P.C.H.Di Permit V_ wn Cp �,w -:4CERTWATE. OF CON STRUr, noN. aW!._, IL J F Q R, S EW Town or via T -BI lot )LOcow at—: 44 Owner/appHdu o a Nam n Subdv. lot # Date Pe 1� Ad" - ruilf aimed' ­ p 7 w ara , t . @.Sewerag e Syqekt v-2 p M Addrew j (;ojilitiag Of Septic Taak atild 7_ r,Supply: Flobne S, p. 1V Moat Addrems Wat� u or vate SipplyDrfted- b* i A Building �Ji�i�CAn fiiid T, Nuniber ofAltedioom's", ':Other R �I certify t'h' atil:t4e ,systam(aj) as, list se were all of the completed,work copies o6 whi6h,- ars attached) and W"P n, 'Putnam .:-co''u-n ty". health, -t.issued'bY,thd- 01 the permf &1� A Jr, 7 12� Any person occupylnp rower- Ises; served by corredio'n`oi any uirisinttary:­- "eon'dltio s iemsuftiiiq front- such tisigs.- -6ikorn It i--:4Pub1z.',sinitwy *or beoorn�:.' 0 an a I of th- I' shiii eiggre -1 !W466h� i-,piibl _4 -avallablk,­ Siich'opprovals are I the ali'prO4 e-, private wafersupp y_,khaftl--bi available. a C9 I IS d'.% ication or c*inglel: wnqfv.. I "Irf the .A09 tw­ I or chan" Is vise Mfy. Date Itto f Al `71 7ftle' f WELL LOCATION WELL UUF1rLLT11JW I tcDrUAI Office Use Only DEPARTMENT OF `HEALTH '-­n.-;D'iVision­,O� ijjiv nt PUTNAM COUNTY DEPARTMENT OF HEALTH SiREEi fiss. TOWNIVILLAGLICIlY TAX GRID NUMBER: c, C7 /t: 0 /e A WELL OWNER NAME: XOORESS: 0481VATE 1P lu C3 PUBLIC USE OF WELL 1- primary 2 - secondary Q RESIDENTIAL ❑ PUBLIC SUPPLY ❑ AIR/COND./HEAT PUMP 0 ABANDONED ❑ BUSINESS ❑ FARM 0 ❑TEST/ OBS ERVATIO N ❑ OTHER (specify) -0 INDUSTRIAL ❑ INSTITUTIONAL, ❑ STAND-BY 0 AMOUNT OF USE YIELD SOUGHT gpm./NO. PEOPLE SERVED EST. OF DAILY USAGE gal. REASON FOR DRILLING, .[]REPLACE EXISTING_ SUPPLY []TEST /OBSERVATION ❑ADDITIONAL SUPPLY ANEW SUPPLY (NEW DWELLING) EIDEEPEN EXISTING WELL DEPTH DATA ft WE LL DE STATIC WAf EA LE!VE� ft: ' DATE MEASURED DRILLING GRILLING 'EQUIPMENT 04ROTARY ❑ COMPRESSED AIR PERCUSSION ❑ DUG ❑ WELL POINT ❑ CABLE PERCUSSION ❑ OTHER (specify): WELL TYPE ❑ SCREENED [p'`OPEN END CASING ❑ OPEN HOLE IN BEDROCK ❑ OTHER CASING DETAILS AIL6 TOTAL LENGTH ILL ft- MATERIALS: [B-STEEL ❑ PLASTIC ❑ OTHER LENGTH BELOW GRADE J 3, ft. JOINTS: 0 WELDED_ -p-THREADED ❑.OTHER:.. DIAMETER in. SEAL:,P..CEMENT GROUT ❑ BENTONITE ❑ OTHER WEIGHT PER FOOT Ib./ft. DRIVE SHOE: ❑ YES L 0,NO_'1 LINER: AYES jQ.NO SCREEN DETAILS DIAMETER (in) 'SLOT SIZE LENGTH (it) DEPTH TO SCREEN (ft) DEVELOPED? IIIIST (?.YES 0 NO.. 'GRAVEL PACK 0 YES O NO GRAVEL SIZE. DIAMETER OF PACK In. TOP DEPTH -,ft. BOTTOM DEPTH It. WELL YIELD TEST ; If detailed'pumping -METHOD: 0 P - UMPED .1 tests were done is in- COMPRESSED AIR formation attached? 0 BAILED 0 OTHER ❑ YES 0 NO WELL LOG -11 more detailed formation descriptions or sieve analy;es' are available, please attach. DEPTH FROM SURFACE Water Bear- ing Well Dia- meter in FORMATION DESCRIPTION Cool! ft. fl WELL OEM ft. DURATION hr. thin. OAAWOOWN YIELD Land S,ri,,e 33 U r Vo 4,: 'SOD WATER 0 CLEAR TEMP. QUALITY 0 CLOUDY HARDNESS 0 COLORED ANALYZED? OYES ONO ANALYSIS ATTACHED? 0 YES ONO 4 t I STORAGE TANK: TYPE CAPACITY GAT.. PUMP INFORMATION TYPE CAPACITY MAKER 1­1 DEPTH C MODEL VOLTAGE �L-1_0 HP3/,! WELL DRILL &R, NAME A DAT5 /I ADDRESS " ot h^ 0 e S Vx T Ly a z1._4.:11 4 SAMPLING .i' n-'e-# --� e mac; SITE �vr ,a ,� � � -✓y i��7y �V 9-o�X Z For Lab Use Only 7, /0,.( V Potable - _ HNO3 pH LT 2 < <4C Nonpotable _ NaOH _ pH GT 9 1/<20>4C HCI Na2S03 >20C COLD BY NOTES] RESULTS OF WATER TESTING YML Environmental LAB NUMBER 817.006945 RESULT UNITS ;yh Services ALKALINITY r J mg/L PATE/TIME TA- K E N ,7 ' �ctawte�ghts' Y 8 C ar StFe . : y TE /TIMERC'D ARSENIC mg/L �Z ¢ ELAP #10323 (914) 245 -2800 COLOR 2 1 Units CONDUCTIVITY DATE REPORTED , COPPER mg/L :... DETERGENTS SAMPLING .i' n-'e-# --� e mac; SITE �vr ,a ,� � � -✓y i��7y �V 9-o�X Z For Lab Use Only 7, /0,.( V Potable - _ HNO3 pH LT 2 < <4C Nonpotable _ NaOH _ pH GT 9 1/<20>4C HCI Na2S03 >20C COLD BY NOTES] RESULTS OF WATER TESTING X ANALYTE RESULT UNITS ALKALINITY mg/L AMMONIA mg/L ARSENIC mg/L CHLORIDE mg/L COLOR Units CONDUCTIVITY umhos /cm COPPER mg/L :... DETERGENTS Jm . FLUORIDE mg& HARDNESS mg/L IRON mg/L LEAD mg/L. MANGANESE mg/L MERCURY mg/L Xl NITRATE mg/L NITRITE mg/L ODOR TON pH S.U. •', . • RESULTS OF WATER TES'T'ING X ANALXTE RESULT UNITS PHOSPHOROUS mg/L SILVER mg/L SODIUM mg/L SULFATE mg/L SULFIDE mg/L SULFITE mg/L TURBIDITY' NTU . :... ZINC. SPC per 1.0 mL Xl TOTAL COLIFORM per 100 mL FECAL COLIFORM per 100 mL E. COLI per 100 mL FECAL STREP. per 100 mL These results indicate that the water sample WAS] [WAS NOT] [NA] of a satisfactory sanitary quality according to the New York State Sanitary Code, for the p ra ers tested, at the-time of sample collection. These results`frtdicate that the wat s mple [WAS] [WAS NOT] A] o a satisfactory chemical quality according to the New York State Sani Cod , r the parameters tested, at t e ti of sample collection. NA = Not Applicable N = Not Present (Negative) SUBMITTED BY. P = Present (Positive) SA = See Attachment(s). " = Also done because Total Coliform was present Albert H. Padovani, M.T. (ASCP) TNTC = Too Numerous To Count Director > = GT = Greater Than < = LT = Less Than PEnwAM COUNTY DEPARTMENT OF HEALIN DIVISION OF ENVIRONMENTAL HEALTH SERVICES 7 / /{ ,,n -�J`. ^`.,rte.'.: cis r::2 a. lS.✓d"^r .-^i':W�'r ~`''C.iay••� :. ,e„J�('��.- ... ..�. � /JQ�, �.� /v J/ �.D - •� /G/ ,. - �.ti.:a4 , .��- q:��.4� _.Q�z::d.e•.:•�M;:::YMt�r_.t:. /� Owner or Purchaser of Building Section Block Lot 7 .. Building Constructed by Location - Street `' 4,�,aar 1/al Municipality Building Type Subdivision Name 2 Subdivision Lot # GUARAME OF SUBSURFACE SEDGE DISPOSAL SYSTEM I represent that I am wholly and completely responsible for the location, workmanship, material, construction and drainage of:the sewage disposal system serving the above described property, -and that it has been constructed as shown on the approved plan or approved amendment thereto, and in accordance with the standards, rules. and regulations of the Putnam-County Department of Health, and hereby guarantee to the owner, his successors, heirs or assigns, to .place in good operating condition any part of said system constructed by me which fails to operate for a period of two years immediately following the date of approval of the "Certificate of Construction Compliance" for the sewage disposal system, or any re irs made' by_ me, to such ..sysc -sn,, except where the failure to operate properly is . �: caused 1Y tfie wiI'Tiu or -fle4i : gent ~ act of -the-odedpant �-of t ie dtid ldi ng- uta lizitag_ ;..r � the system. The undersigned further agrees to accept as conclusive the determination of the Director of the Division of Environmental Health Services of the Putnam County Department of Health as to whether or not the failure of the system to operate was caused by the willful or negligent act of the occupant of the building utilizing the system. Dated this Z- day of dQ7 19f-3 Signature 1009, V Title �co General Contractor (Owner) Cn Signature . . ., .. ., Corporation Name (if Corp.) Corporation Name (if Corp.) Address rev. 9/85 mk DEPARTMENT OF HEALTH Division of Environmental Health Services 110 OLD ROUTE SIX CENTERV CARMEL, N.Y. 10512 (914) 225 -0310 V,; C vC� UST A WATE2 WELL PCHD PERMIT' IB.L LOCAT I ON treet Address ran Village ity Tax Grid Number WELL OWNER ame �. r� �`-�.0 Mailing 6-Address �l rivate JAL ��j% J�� Public USE OF WELL 1 - primary 2 - secondary RESIDENTIAL ® BUSINESS 0 INDUSTRIAL ® PUBLIC SUPPLY - ❑ AIR /CdND /HEAT /PUMP ® ABANDONED 0 FARM 0 TEST /OBSERVATION 0 OTHER (specify (.3 INSTITUTIONAL 0 STAND -BY 0 AMOUNT OF USE YIELD SOUGHT L gpm /# PEOPLE SERVED /EST. OF DAILY USAGE &0 Sal ® REPLACE EXISTING SUPPLY ® TEST /OBSERVATION ADDITIONAL SUPPLY SUPPLY NEW DWELLING ® DEEPEN EXISTING WELL REASON FOR DRILLING DETAILED REASON FOR DRILLING WELL TYPE DRILLED El DRIVEN ®DUG ®GRAVEL. 0 OTHER IS WELL SITE SUBJECT TO FLOODING? YES Y' NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: Lot No. DATER TELL CONTRACTOR: Name Address: IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: YES i--" NO NMZ OF PUBLIC WATER SUPPLY: "' TOWN /VIL /CITY -� D•ISTAMCE- TO-VROP1 Tl'. ' ' •'NE.9 - GbATER -MAll-Ai LOCATION SKETCH SOURCES OF.CONTAMINATION PROVIDED ®0N SEPARATE SHEET -(date) (signature) PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirt�� (30) days of the completion of water well construction, the applicant shall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. During all well drilling operations, the applicant shall take appropriate action to assure that any and all water or waste products from such well dril operations be contained on this property and in such.a manner as not to degrade or of w' a contaminate surface or groundwater. Date of Issue: 9. 19 Date of Expiration 2- 2 4; 19- Permit Issuing Official Permit is Non - Transferrable White copy: HD File Pink copy: Owner 3/89 Yellow copy: Bldg. Insp. Orange copy: Well Driller Re: Property PUTNAM COUNTY DEPARTMENT OF HEALTH DIVISION OF,ANVIROMMTAL -HEALTH.- SERVICES.,.­ Date J' AZ ^-6 Located at-- C-r- //--* -17 / /f ✓rzi/ /,p (T) Section Block Lot � e Subdivision -OU.' Y?�-e_Aa '4, A Subdv. Lot-4 2 Filed Map # This letter in to authorise V4 .� / a duly licensed professional engineer o or registered architect Undica fi_ to apply for a Construction Permit for a separate sewaSo system, to serve the abQve.note4.prqpsrty in accordance with the standards, rules or regulations an pr"ula% ' pked by the Commissioner of the Putnam County Department of Health, and to sign all necessary papers on my behalf in connection with this matter and to supervise the construction of said system or systems in conformity with the provisions of Article 145 or 147, Education Low, the Public Health leawl and the Putnam County Sani- tar,y Code* very truly Yo urs, Signed "f bf Propitty CoUntersi a lei 7 Z Address g 0 ge Address Town' -7 /J) 6 Telephone a. O JOSEPH F. SULLIVAN, P. E. '' LL rnonsuitiny �n9uzcat _ .':YV .r -. �y.'.� . -.�.,. iLF.L :.�y.y:.. - a- »r" >'x �..7Y> - rw +`. =ri��: e. ae:. 2�7i:�- ERNCI�STrL�t�IMc• ",: �� t. .��...ti�vi :_' ��t' f'. f: ci�,.':Fw- s::.."- ,�= .::o.'w %.�S '�"ri..Q:.� r. ,. YORKTOWN HEIGHTS, N. Y. 1059B (914) 962 -4248 February 20, 1992 Putnam County Department of Health 110,01d Route 6 Carmel, New York 10512 Gentlemen: Enclosed please find plans, construction permit and application forms required for a renewal of the sewage disposal permit for Mr. Steve Orefice on Peekskill Hollow Turnpike in -the Town.of Putnam Valley, Putnam County, New York (92.8 -1 -16) (your file no, PV1 -90). From a site inspection.-of the above lot, there have been no changes to adversely affect this proposed sQ_sy:e?n.gr thP. ?ooaign�6f_t- Yw,e'1� Very truly yours, Joseph F. Sullivan, Po E. JFS /ats #90 ®3 / A , 1r` T D' i7 kr � N, ^: r M� �'• 1 ARTMENT PUTNAM COUNTYDEP OF HEALTH , 7 11.. Dlylatoo of Eevlronmentil'Hedt6,Servtcoa Carmol.' N:Y 10511 ... _.. EnQlneer to Provide Pecmll M: on CERTIFYCATE•OF.CO CE :.. Permit N �- ., CONST�UCTIO FO8 SEWAGE, DISPOSAL SYSTEM / Coe iA A7 Towu Looted et" 3 ✓/ ��� /�O�y' "> _ ar .Village c .v�i�« -vt" 'r.ey.+4 .:; -.�-, Sabdivbbn Name � ,�A -4. K. y. • .e.� c�s..iy «. %mot c�i. ..r .ee .:+'� .i. w.6• M.ew a r. �w.4�..' w•/ ..e�.'�.. -.: 'w ..-:.o- Sabel. Lot N Tat Map Block /� Lot ,[ Renewal_ ❑ Revtelon ❑ S✓ �i' Owner/ Applicant Name fir!^ iG iiC a� Date of Prevlode Approval' �± / Town Zip I� Ma111oS Address -� Banding Type / "T! ' Lot Atea 7J f FM Section Only peptb Volume Number of Bedrooms - Deelin Flow G `P: D PCHD Not�c tlon U Regaired When FW Is completed ` sePer-to Sew•eeaiz System to coaslat of .Gallon Septic Tank`aaa - To be ootuteacted by d tn✓ g �iL.. • Addrexe Water SuPPb pdblic Supply Ffrom Address' ti "o -4 G/a orl G� piivate Supply. Denied byA e , •. Other Reaalremenb ., i Y 0000r Rev. 1/87 an" 9 1 the fpproval of the Cert,ficate. •of Construction 'Compliance of the will be located as shown on the Dprovpd plan and "that fa�0 well will ba;`installed County De rtinent `of Health Oats. �%�, fy Siynad Address! /'�� T.tG�s/7%[::� r APPtiOV.ED FOR CONSTRUCTION This approval expires two years 'from M_a fevocible'for cause or :may' be� amended of modified when _consitlered necessary' requires 'a n w per mit T` AApproved for dispowt'of domestic�sama`y`fdwage ". Oats BYr� — rules and regu s o e• • u nam iiy to.tlie CoMmitsionai'of Health will *'by the builder that is builder Will t: P.E. A.A. _ ` •22 icense 1�". y aro 'ilding has been undertaken and Is e ,qjth.ange or alteration of construction Is DEPARTMENT OF HEALTH Division of Environmental Health Services TWO COUNTY CENTER - CARMEL, N.Y. 10512 (914) 225 -3641 APPLICATION TO CONSTRUCT A WATER WELL �j' PCHD PERMIT #/ G / _1- /P WELL LOCATION Street Addre � Town Villige City /y Tax Grid Number WELL OWNER . Name Mailing Address X/ p'° motivate U Public USE OF WELL 1 - primary 2 - secondary ESIDENTIAL BUSINESS ® INDUSTRIAL ® PUBLIC SUPPLY' Q AIR /COND /HEAT PUMP ❑ FARM Q TEST /OBSERVATION 0 INSTITUTIONAL Q STAND -BY Q ABANDONED [3 OTHER (specify AMOUNT OF USE YIELD SOUGHT -,I' gpm /# PEOPLE SERVED /EST. OF DAILY USAGE X40 gal REASON FOR DRILLING 'KEW SUPPLY ❑ PROVIDE ADDITIONAL SUPPLY O REPLACE EXISTING SUPPLY ® DEEPEN EXISTING WELL ® TEST OBSERVATION DETAILED REASON FOR DRILLING WELL TYPE U6DRILLED [3DRIVEN • :: []DUG -[]GRAVEL OTHER IS WELL SITE SUBJECT TO FLOODING? YES Po" NO IF WELL IS LOCATED IN A REALTY SUBDIVISION, NAME OF SUBDIVISION: ,0se -04' _A:-.s rs. :.Lot No. 2- WATER WELL CONTRACTOR: Name IS PUBLIC WATER SUPPLY AVAILABLE TO SITE: Address: /UA YES A" NO NAME OF PUBLIC WATER SUPPLY: TOWN /VIL /CITY •_v t... ... ..a= �..� •��•:.. � ca. ..- �.'i'.. ._ :�y4�'.5... .�.5 ..�.�> .•F .. . w� . • —a C.. ...�i.�. ~. DISTANCE TO PROPERTY FROM NEAREST MAIN:K�i -;4 LOCATION SKETCH & SOURCES OF CONTAMINATION PROVIDED []ON REAR OF THIS APPLICATION []ON SEPARATE S T (d e) dr,�a1 a% PERMIT TO CONSTRUCT A WATER WELL This permit to construct one water well as set forth above is granted under the provisions of Subpart 5 -2 of Part 5 of the New York State Sanitary Code, and provided that within thirty (30) days of the completion of water well construction, the applicant s.hall: 1. Pump the well until the water is clear. 2. Disinfect the well in accordance with the requirements of the Putnam County Health Department attached to this permit. 3. Submit a Well Completion Report on a form provided by the Putnam County Health Department. Date of Issue: �-� Sr 19 � Date of Expiration: 19 - ermit Issuing ficia Permit is Non - Transferrable White copy: H.D. File Yellow copy: Building Inspector Pink Copy: Owner 2 87 Orancre couv: Well Driller 1 CA gal 111109. _. . _. r APPEND= END= H P �I`:�_ "_ � : DE✓'?= � �i7T OF Dr1- TZ-:EOI GF LVL�C` S- S JppfL oc E"•i u�rF?�' SSE —r-.•' DIS SiFZ'�S .... -��,.! � Y'•F., ui'. •—� _..\ r��v.:�.� L`. Tl�i.V�.17'���{� Ko -; :1 V.NI�r�c��S.�. ¢�:� y ?��+5�..: fyi'� (,21:a OL Cvi_ =fi (Jl= r lACr_Cr��b ca.m Y YE. { NO I PPr-lit P-r-Z1 i =ticn C--r- -Cram Resolut =C1 Pla_rls - T^--rzz s`,.- E;ail.T'�'.� Ccasi s a t_ Pere. re_ —, t= ( 3 Parc E^1_ C'e_ t_-1 S7aD:, -, c CL� C=._ Ec'�e Pl a-:= - Two s=== Va iEac_= P.e=zest �i - ✓i'v'JG? S�LS C�� Lam. t..:. ..._�....C.. (-C'ri i_ /DEC = °_ - _ R & ca—L- Ca VCs pi ,= & Eva-Em P! ` ^_ de +�.ys =n`C larft -- S_Ze, Ce_i T.J� _cct Crrtot?rs �ti =tic & Prc_c =_r Dr T eva-V & Sic—c—= Cat 1= P. Pit & D BCX Si?C.vra & Ce_i1= ficL- - 'N cL _ _ SYel� SSCS' ri /_'' LnO C= Ec'se SaJcr - 1 /4 " /"f =- c "D; Inc ,�_, if�..•t. Ee = 4-5, 10' to P. L. Dri��e:Jar, L -r:- L`== ==,TCC c: _ 20' to Wac l s 100' to Well; 200' i� D.L.C.D, 130' loo to S`:e= -al, jVct__cour =c, �i.': ( =CC. e`rz 15' tO 10' C 50' lye ~. CZ-- -,Ze CC C J PUTNAM COUNTY DEPARTMENT OF HEALTH -D-IV-IS,IO.N,;-OF.:ENVIRO,-*X-NT- AT4-`-�`SERVICi Date Re: Property of e Located at e-, , 111je.; t*" A S Block Lot (T) Section 7 Subdivision of e_ 4111 Subdv. Lot # Filed Map Date Gentlemen: This letter is to authorize v duly licensed professional engineer or registered architect (Indicate —0 :o apply for a Construction Permit for a separate sewage system, to serve the above noted property in accordance with the standards, rules or regulations an promulagated by the Commissioner of the'Putnam County Department of Health, and to sign all necessary papers on my behalf in 'Connection-Yith- ths' matk- Fgr end = =to supVryise th system or systems in conformity with the provisions of Article 145 or 147, Education Law, the Public Health Law, and thePutnam County Sani- tary Code. Countersig e r a P. E. R * I'* 10 Aaaress Telephone Very truly yours, 00 Signed ropii-ty 7 Address /7r" 'le, 0 91 Town Telephone 11 't O APPENDIX J ....PUTNAM COUNTY DEPARTMENT OF HEALTH _. DIVISION OF ENVIRONMENTAL. HEALTH. SERVICES DESIGN CATA;FIFET -. SUBSUFAGE- SEWAGE:�'DISPOSAL': SYSTEI�1: T: <; 'IT N0. Owner, e �e_- G= Address Located at (Street) w - %�`z'•�✓ �' Sec. Block Lot 7. J. (indicate nearest cross .y° Municipality ty`� Watershed SOIL PERCOLATION TEST DATA REQUIRED TO'BE SUBMITTED WITH APPLICATIONS Date of Pre - Soaking %j° 9-el. Date of .Percolation' Test HOLE jr NUMBER CLACK TIME ;: PERCOLATION PERCOLATION Run Elapse. Depth to Water From Water. Level _ No. Time Ground Surface -, In Inches Soil Rate . Start -Stop Min. „ Start °..'Stop Drop In Min /In Drop Inches . finches Inches 3'e/ 4 5 3%� 4 5 ...... NOTES: 1. Tests to be repeated at same depth . until..approximately -equal soil -rates are.obtained.at each.percolation test hole. All data'to be submitted for review. 2. Depth measurements to be made frcm top of hole. rev. 9/85 _. 17 mk 0 TEST PIT DATA REQUIRED TO BE 'SUBMITTED WITH APPLICATION DESCRIPTION OF SOILS ENCOUNTERED IN TEST HOLES ' DEPTH HOLE NO. HOLE NO. 2— HOLE NOe_ _ -a-• -a R„ 6: - Y.. . ^;s's. �'Y ..i y .'j'. . - .. • "CP• :.. ., . Pi1`i r 4`-. _ c - • v�'T 9'r�i %r� ^ ' 7 4.e,? M - .Y et ','^s.;.' C -_`,': _ - . 4": - -a:.•. ieii .-: Oir�e ,. �., it. n.+s. ,!'. G.L. 2' 49 A 5 of 7' N g° 10' 11° 12' 13' 14° INDICATR ISVEL :AI'-tffiICEI GROUNDWATER -IS. ENCOUNTERED—* INDICATE LEVEL TO WHICH WATER LEVEL RISES AFTER BEING ENCOUNTERED DEEP HOLE OBSERVATIONS MADE BY: c% // /' oar ?? - DATE° R DESIGN Soil Rate Used Min /1" Drop: Sabo Usable Area Provided Noe of Bedroans Septic 'Tank Capacity ✓ gals° Type ./��`�f ✓> �° --�'�) D Absorption Area Provided By / L.F. ' width tr ch Other �i O PU Name ! �� Signatur _ � Y Address S y� E�n.NC'lt 0. ONLY: Soil Rate Approved sq "eft /gal. Checked by Date a- _ � -. • - _ � _ .. . .. - _ � ,.. ---- t _ ._ „�_� "_: t!'.; r t t� s: ;t t--,: b �'�-� � G sir• � , r' �,..F' ,. __ � _� � .o ..ri�„r r.:% t -y�,,. ",i:f- - ' -sue z'�,4- }+,s:-•,- - ,-4-�: - - "mil . r _ _ t b �'�-� � G sir• � , r'